No new evidence found to support reversal of USPSTF 2004 recommendation against screening

-- Jeff Muise

Tuesday, September 21, 2010 (Last Updated: 09/22/2010)

TUESDAY, Sept. 21 (HealthDay News) -- No new evidence has emerged warranting a change in the U.S. Preventive Services Task Force's (USPSTF's) 2004 conclusion that screening asymptomatic men for testicular cancer is unlikely to offer benefits over clinical detection, according to a literature review in the Sept. 21 issue of the Annals of Internal Medicine.

Kenneth Lin, M.D., and Ruta Sharangpani, M.D., of the Agency for Healthcare Research and Quality in Rockville, Md., screened 113 studies on testicular cancer published during 2001 to 2009 to re-evaluate the USPSTF conclusion. No studies met the reviewers' inclusion criteria, primarily because the studies were conducted in symptomatic populations. Ultimately, the researchers reviewed three inconclusive studies on testicular microlithiasis, XIST gene testing, and testis-sparing surgery.

The reviewers found that no conclusions about screening could be drawn from one study on the association between testicular microlithiasis and testicular cancer, while another on the XIST gene as a marker for testicular cancer had too small a sample size and a lack of outcome data. A third study on testis-sparing surgery found that the surgery did not increase the risk for recurrent cancer, but the study did not address screening in asymptomatic men. The reviewers concluded that there is no new evidence on the harms or benefits of testicular cancer screening that would affect the USPSTF's 2004 recommendation.

"Although these studies do not directly address the benefits of screening, they serve as a reminder for primary care clinicians to consider testicular cancer as part of their differential diagnosis in patients with testicular or scrotal symptoms. As the USPSTF stated in a previous recommendation statement, although the average primary care physician may see only one patient with testicular cancer over 20 to 25 years, 26 to 56 percent of patients with testicular cancer had an initially incorrect diagnosis of another testicular disorder," the authors write.